title: Understanding the unperceivable: ideas about cholesterol expressed by middle-aged men with recently discovered hypercholesterolaemia.
abstract: OBJECTIVE
  We aimed to describe the perception of hypercholesterolaemia among middle-aged, urban men who had recently received the diagnosis of moderate hypercholesterolaemia.
  
  
  METHODS
  Within a project screening for risk factors for coronary heart disease among 453 men, 63 were identified as moderately hypercholesterolaemic. Among these, 62 agreed to tape-recording and transcription of the first counselling on lipid-lowering, supplied by a registered nurse. The counselling was tailored to fit the needs of the individual patient, taking a starting point in whatever questions the patient expressed. The transcripts of the counselling sessions were analysed for their content.
  
  
  RESULTS
  Five major themes were addressed by the men. It was hard to understand and accept the concept of hypercholesterolaemia, as the men did not feel unwell, and thus they did not receive any cues to taking action. Obesity and smoking was regarded as causes of hypercholesterolaemia, although the link between life-style and cholesterol level was unclear. Some men were aware of heredity traits of hypercholesterolaemia. Treatment suggestions included weight reduction and drug treatment, although there were ambiguous feelings towards drugs. Numerous misconceptions about diet were found. Many men expressed resistance to life-style changes and questioned the benefits of risk reduction. Information about hypercholesterolaemia was regarded as unreliable, as different sources gave incongruent information, and the information from individual sources changed over time.
  
  
  CONCLUSIONS
  Unless medical professionals counselling patients for asymptomatic risk factors make efforts to disclose patients' conceptions of the condition, patients may misunderstand and counselling may become ineffective.
authors.affiliation: Department of Community Medicine, Lund University, Malmö University Hospital, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Troein
authors.forename: L
authors.initials: L
authors.lastname: Råstam
authors.forename: S
authors.initials: S
authors.lastname: Selander
authors.forename: M
authors.initials: M
authors.lastname: Widlund
authors.forename: G
authors.initials: G
authors.lastname: Udén
mesh_terms: D000328:Adult; D001294:Attitude to Health; D015331:Cohort Studies; D003376:Counseling / Q000379:methods; D003717:Denial, Psychological; D006801:Humans; D006937:Hypercholesterolemia / Q000523:psychology* / Q000628:therapy; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012307:Risk Factors; D012494:Sampling Studies; D012803:Sick Role; D013548:Sweden